Oral cancer kills 9,750 people per year in the United States, more than skin cancer and cervical cancer. Each year 49,750 new cases are diagnosed. Oral cancer occurs more often in people who use tobacco, no matter the form, including cigarettes, chewing tobacco, pipes, cigars and in people who consume large quantities of alcohol, especially liquor. It can occur in all ages, races, and lifestyles. However, these demographics are changing. Recently a new cause of oral cancer has been discovered, the HPV or human papilloma virus. The same cause as cervical cancer. Over 25 percent of oral cancers occur in people who do not smoke and only drink alcohol socially. This survival rate has improved from 50 years to 57 years recently. Early detection with oral cancer screenings plays a much greater role in these improvements rather than advances in treatment. The following yearly tests have greatly improved the survival rates of the following cancers: the mammogram for breast cancer, the PSA for prostate cancer, the PAP smear for cervical cancer, and the colonoscopy for colon cancer. There are several factors that make early detection difficult. The lesions can take on many different forms. It may be small, flat, a red or white patch, a growth, a lump, a thickening, a rough spot, crusted, or an irritated area. They are often painless. Many mouth lesions are in areas that are difficult to see, requiring examination by a dentist or dental hygienists. Until recently, suspicious lesions required a surgical biopsy for diagnosis. The logistics involved and the nature of the procedure caused the patient as well as the dentist to delay the procedure. Fortunately, Delmarva Dental Services uses a new test that is simple to perform and similar to a PAP smear. We just brush the surface of the suspected area several times and send the specimen to the laboratory. The lab sends the results in a few days. Areas that test positive can be surgically biopsied or totally removed. Areas that test normal have avoided the more complicated surgical biopsy and the patient can feel reassured. We also use a saliva test for HPV virus. The simplicity of these tests will allow oral cancer survival rates to improve, provided people come to the dentist for their checkups.
Oral Effects of Chemotherapy
Most everyone knows that chemotherapy is the use of drugs to kill cancer cells. However, it also kills normal cells in the body. My family (Dr. Harmon’s) witnessed this when our one-year-old son was diagnosed with hepatoblastoma in 2001. He underwent 10 months of chemotherapy and had two-thirds of his liver removed. Our son Michael is now cancer free. Most of the side effects of chemotherapy involve the stomach lining and the ability to fight infection. It can also affect the oral cavity as well. This involves the teeth, gums, tongue, and the soft tissue on the inside cheek and roof of the mouth. The salivary glands can also be affected. Oral effects of chemotherapy can reduce salivary flow resulting in dry, burning, peeling mouth, reduced and or metallic taste, and susceptibility to infection and cavities. Prevention is the best measure. Prior to chemotherapy, a dentist should see you to ensure that your teeth are in optimum health. Your teeth should be cleaned, known and unknown infections treated, cavities filled, and potential problems corrected. You should also receive a prescription for fluoride rinse or gel. Dentures that do not fit well should be adjusted, repaired, relined, or remade. During chemotherapy drink plenty of water, chew Xylitol gum, and suck on sugarless candy to keep your mouth moist. Brush your teeth with an extra soft toothbrush after meals and at bedtime. Floss every day and use your prescription fluoride supplement.
Oral Cancer and Oral Sex
Oral cancer will be diagnosed in 40,000 Americans this year. Of those, 43 percent will be dead in five years. This cancer is more prevalent and more lethal than cervical cancer which will affect 12,000 women with a 32 percent death rate. It has been a disease that has mostly affected males who smoked and drank alcohol. However this is changing and now women and men in their 20 and 30’s are being diagnosed with oral cancer.
There is now a new kind of oral cancer, caused by a virus as opposed to the typical oral squamous cell cancer similar to skin cancer. It is the human papilloma virus (HPV), which is the same virus transmitted sexually that causes cervical cancer in women. This is transmitted by oral sex. There are 150 different HPV strains. Sixty of them cause the kind of wart you get on your skin and 40 of them are sexually transmitted. Of these 40 HPV strains, about 8 cause cancer and 2 cause 70 percent of the cancers. Unfortunately, you may have the virus and not know it because you don’t always get a wart.
So how common is this HPV sexually transmitted disease? It is the most common sexually transmitted disease in the United States with 79 million people infected. Twenty million people become infected per year and 70 percent of them are between the ages of 15 and 24. These numbers will only rise because if it is in the mouth it has the potential to be spread by deep kissing. HPV can also cause anal and penile cancer. The good news is that most people who have HPV will not get cancer because their immune system will fight it off and or they have a less virulent virus. However, individuals with weakened immune systems are more susceptible. A John Hopkins study found that marijuana increases the risk of oral cancer in patients who have HPV. It is theorized that marijuana weakens the immune system. Also, oral HPV cancer is more easily treated than squamous cell oral cancer. So what can be done about this? First, there is a vaccine for women called Cervarix and one for both men and women called Gardasil. Both boys and girls should get vaccinated around age 11. Second, teenagers and adults should have regular oral cancer exams by a dentist so suspicious lesions can be biopsied or removed. Thirdly, avoid multiple sexual partners, but most importantly save yourself for your husband or wife as God instructs you to do.